自体肺动脉补片主动脉弓成形治疗婴儿主动脉缩窄合并弓发育不良

Objective To discuss the operative techniques and results of coarctation resection plus aortoplasty with pulmonary autograft patch for coarctation of the aorta combined with hypoplastic aortic arch in infant.Methods Between May 2007 and Dec 2009,14 cases including 9 males and 5 females with caorctation of the aorta and hypoplastic aortic arch underwent coarctation resection plus aortoplasty with pulmonary autograft patch in our hospital.The age ranged from 23 days to 17 months,with a median of 4.33 months.The mean body weight was (6.14 ±2.36) kg.All patients were diagnosed as aortic coarctation combined with VSD and hypoplastic aortic arch.The surgery was performed under deep hypothermia cardiopulmonary bypass with selective cerebral perfusion in 8 cases and circulation arrest in 6 cases.Fresh pulmonary autograft patch harvested from the main pulmonary artery was used for aortoplasty.The associated VSD was repaired in the same stage.Results All patients survived except one died from circulatory failure during the perioperative period.Low cardiac output syndrome occurred in another case who was cured afterwards by correspondent treatments.No residual obstruction was detected by echocar-diography after the operation.Follow-up was carried out in 13 cases from 4 months to 3 years.Echocardiographic examination showed that the pressure gradient across the aortic arch was less than 16 mm Hg in all cases.The blood velocity at the descending aortic arch was not significantly changed during the follow-up period as compared with that of the immediate after operation.Computed tomography showed that the morphology of aortic arch was normal.The left bronchus compression was relieved obviously or totally disappeared in patients who suffered from left bronchus stenosis before operation,and no aortic aneurysm were detected in these patients.Conclusion Conclusion Coarctation resection plus aortoplasty with pulmonary autograft patch is the optimal surgical method for treating coarctation of the aorta combined with hypoplastic aortic arch in infant.     

自体肺动脉补片主动脉弓成形治疗婴儿主动脉缩窄合并弓发育不良

Objective To discuss the operative techniques and results of coarctation resection plus aortoplasty with pulmonary autograft patch for coarctation of the aorta combined with hypoplastic aortic arch in infant.Methods Between May 2007 and Dec 2009,14 cases including 9 males and 5 females with caorctation of the aorta and hypoplastic aortic arch underwent coarctation resection plus aortoplasty with pulmonary autograft patch in our hospital.The age ranged from 23 days to 17 months,with a median of 4.33 months.The mean body weight was (6.14 ±2.36) kg.All patients were diagnosed as aortic coarctation combined with VSD and hypoplastic aortic arch.The surgery was performed under deep hypothermia cardiopulmonary bypass with selective cerebral perfusion in 8 cases and circulation arrest in 6 cases.Fresh pulmonary autograft patch harvested from the main pulmonary artery was used for aortoplasty.The associated VSD was repaired in the same stage.Results All patients survived except one died from circulatory failure during the perioperative period.Low cardiac output syndrome occurred in another case who was cured afterwards by correspondent treatments.No residual obstruction was detected by echocar-diography after the operation.Follow-up was carried out in 13 cases from 4 months to 3 years.Echocardiographic examination showed that the pressure gradient across the aortic arch was less than 16 mm Hg in all cases.The blood velocity at the descending aortic arch was not significantly changed during the follow-up period as compared with that of the immediate after operation.Computed tomography showed that the morphology of aortic arch was normal.The left bronchus compression was relieved obviously or totally disappeared in patients who suffered from left bronchus stenosis before operation,and no aortic aneurysm were detected in these patients.Conclusion Conclusion Coarctation resection plus aortoplasty with pulmonary autograft patch is the optimal surgical method for treating coarctation of the aorta combined with hypoplastic aortic arch in infant.     

升主动脉成形术中期效果分析

Objective Reduction ascending aortoplasty is an alternative procdure to the replacement of the ascending aorts in case of ascending aorta dilation. However,its applicabikity is still under debate.This retrospective study was designed to evaluuate the midterm follow-up of unsupported ascending reduction aortoplasty for of the ascending aorta in petients with aortic valve dis- ease.Methods From October ,1996 to April,2007, a total of 54 patients with aortic valve disease and dilatation of the ascending aorta underwent unsupported reduction aortoplasty in combination with aortic valve replacement at our institution The diameter of the ascending aorta was measyred before and early after sugery and then later between 13 and 96 menths [mean (23 ±16)months] posto- perativeiy using echocardiography.Results Two patients were dead with thean overall perioperative mortality rate was of 3.7%. The reduction aortoplasty decreased the diameter of the aorta from (45.77±6.02) mm p～eope～afive]y to (34.67 ～4.81) mm early after surgery (P<0.01). During follow-up, the diameter d aorta increased from (34.67±4.81) mm early after surgery to (37.65± 6.35) mm after a mean follow-up of (23±16) months (P<0.01), including the diameters are greater than > 45 mm within 5 pa- tients. Aortic stenosis and an early postoperative diameter greater than 40 mm m'e independent risk factors for redilatation. Conchusion Because of the unsatisfied midterm follow-up redilation of unsupported reduction aortoplasty for dilation of the ascending aorta with aortic valve disease, this group of patients needs continued intimate fallow-up or even reoperation. The patients of stenosis is the surtable indication for RAA, and it is necessary to reduce the diameter of aorta to be lees than 40 mm to prevent redilation.     

升主动脉成形术中期效果分析

Objective Reduction ascending aortoplasty is an alternative procdure to the replacement of the ascending aorts in case of ascending aorta dilation. However,its applicabikity is still under debate.This retrospective study was designed to evaluuate the midterm follow-up of unsupported ascending reduction aortoplasty for of the ascending aorta in petients with aortic valve dis- ease.Methods From October ,1996 to April,2007, a total of 54 patients with aortic valve disease and dilatation of the ascending aorta underwent unsupported reduction aortoplasty in combination with aortic valve replacement at our institution The diameter of the ascending aorta was measyred before and early after sugery and then later between 13 and 96 menths [mean (23 ±16)months] posto- perativeiy using echocardiography.Results Two patients were dead with thean overall perioperative mortality rate was of 3.7%. The reduction aortoplasty decreased the diameter of the aorta from (45.77±6.02) mm p～eope～afive]y to (34.67 ～4.81) mm early after surgery (P<0.01). During follow-up, the diameter d aorta increased from (34.67±4.81) mm early after surgery to (37.65± 6.35) mm after a mean follow-up of (23±16) months (P<0.01), including the diameters are greater than > 45 mm within 5 pa- tients. Aortic stenosis and an early postoperative diameter greater than 40 mm m'e independent risk factors for redilatation. Conchusion Because of the unsatisfied midterm follow-up redilation of unsupported reduction aortoplasty for dilation of the ascending aorta with aortic valve disease, this group of patients needs continued intimate fallow-up or even reoperation. The patients of stenosis is the surtable indication for RAA, and it is necessary to reduce the diameter of aorta to be lees than 40 mm to prevent redilation.     

升主动脉成形术中期效果分析

Objective Reduction ascending aortoplasty is an alternative procdure to the replacement of the ascending aorts in case of ascending aorta dilation. However,its applicabikity is still under debate.This retrospective study was designed to evaluuate the midterm follow-up of unsupported ascending reduction aortoplasty for of the ascending aorta in petients with aortic valve dis- ease.Methods From October ,1996 to April,2007, a total of 54 patients with aortic valve disease and dilatation of the ascending aorta underwent unsupported reduction aortoplasty in combination with aortic valve replacement at our institution The diameter of the ascending aorta was measyred before and early after sugery and then later between 13 and 96 menths [mean (23 ±16)months] posto- perativeiy using echocardiography.Results Two patients were dead with thean overall perioperative mortality rate was of 3.7%. The reduction aortoplasty decreased the diameter of the aorta from (45.77±6.02) mm p～eope～afive]y to (34.67 ～4.81) mm early after surgery (P<0.01). During follow-up, the diameter d aorta increased from (34.67±4.81) mm early after surgery to (37.65± 6.35) mm after a mean follow-up of (23±16) months (P<0.01), including the diameters are greater than > 45 mm within 5 pa- tients. Aortic stenosis and an early postoperative diameter greater than 40 mm m'e independent risk factors for redilatation. Conchusion Because of the unsatisfied midterm follow-up redilation of unsupported reduction aortoplasty for dilation of the ascending aorta with aortic valve disease, this group of patients needs continued intimate fallow-up or even reoperation. The patients of stenosis is the surtable indication for RAA, and it is necessary to reduce the diameter of aorta to be lees than 40 mm to prevent redilation.     

升主动脉成形术中期效果分析

Objective Reduction ascending aortoplasty is an alternative procdure to the replacement of the ascending aorts in case of ascending aorta dilation. However,its applicabikity is still under debate.This retrospective study was designed to evaluuate the midterm follow-up of unsupported ascending reduction aortoplasty for of the ascending aorta in petients with aortic valve dis- ease.Methods From October ,1996 to April,2007, a total of 54 patients with aortic valve disease and dilatation of the ascending aorta underwent unsupported reduction aortoplasty in combination with aortic valve replacement at our institution The diameter of the ascending aorta was measyred before and early after sugery and then later between 13 and 96 menths [mean (23 ±16)months] posto- perativeiy using echocardiography.Results Two patients were dead with thean overall perioperative mortality rate was of 3.7%. The reduction aortoplasty decreased the diameter of the aorta from (45.77±6.02) mm p～eope～afive]y to (34.67 ～4.81) mm early after surgery (P<0.01). During follow-up, the diameter d aorta increased from (34.67±4.81) mm early after surgery to (37.65± 6.35) mm after a mean follow-up of (23±16) months (P<0.01), including the diameters are greater than > 45 mm within 5 pa- tients. Aortic stenosis and an early postoperative diameter greater than 40 mm m'e independent risk factors for redilatation. Conchusion Because of the unsatisfied midterm follow-up redilation of unsupported reduction aortoplasty for dilation of the ascending aorta with aortic valve disease, this group of patients needs continued intimate fallow-up or even reoperation. The patients of stenosis is the surtable indication for RAA, and it is necessary to reduce the diameter of aorta to be lees than 40 mm to prevent redilation.     

升主动脉成形术中期效果分析

Objective Reduction ascending aortoplasty is an alternative procdure to the replacement of the ascending aorts in case of ascending aorta dilation. However,its applicabikity is still under debate.This retrospective study was designed to evaluuate the midterm follow-up of unsupported ascending reduction aortoplasty for of the ascending aorta in petients with aortic valve dis- ease.Methods From October ,1996 to April,2007, a total of 54 patients with aortic valve disease and dilatation of the ascending aorta underwent unsupported reduction aortoplasty in combination with aortic valve replacement at our institution The diameter of the ascending aorta was measyred before and early after sugery and then later between 13 and 96 menths [mean (23 ±16)months] posto- perativeiy using echocardiography.Results Two patients were dead with thean overall perioperative mortality rate was of 3.7%. The reduction aortoplasty decreased the diameter of the aorta from (45.77±6.02) mm p～eope～afive]y to (34.67 ～4.81) mm early after surgery (P<0.01). During follow-up, the diameter d aorta increased from (34.67±4.81) mm early after surgery to (37.65± 6.35) mm after a mean follow-up of (23±16) months (P<0.01), including the diameters are greater than > 45 mm within 5 pa- tients. Aortic stenosis and an early postoperative diameter greater than 40 mm m'e independent risk factors for redilatation. Conchusion Because of the unsatisfied midterm follow-up redilation of unsupported reduction aortoplasty for dilation of the ascending aorta with aortic valve disease, this group of patients needs continued intimate fallow-up or even reoperation. The patients of stenosis is the surtable indication for RAA, and it is necessary to reduce the diameter of aorta to be lees than 40 mm to prevent redilation.     

升主动脉成形术中期效果分析

Objective Reduction ascending aortoplasty is an alternative procdure to the replacement of the ascending aorts in case of ascending aorta dilation. However,its applicabikity is still under debate.This retrospective study was designed to evaluuate the midterm follow-up of unsupported ascending reduction aortoplasty for of the ascending aorta in petients with aortic valve dis- ease.Methods From October ,1996 to April,2007, a total of 54 patients with aortic valve disease and dilatation of the ascending aorta underwent unsupported reduction aortoplasty in combination with aortic valve replacement at our institution The diameter of the ascending aorta was measyred before and early after sugery and then later between 13 and 96 menths [mean (23 ±16)months] posto- perativeiy using echocardiography.Results Two patients were dead with thean overall perioperative mortality rate was of 3.7%. The reduction aortoplasty decreased the diameter of the aorta from (45.77±6.02) mm p～eope～afive]y to (34.67 ～4.81) mm early after surgery (P<0.01). During follow-up, the diameter d aorta increased from (34.67±4.81) mm early after surgery to (37.65± 6.35) mm after a mean follow-up of (23±16) months (P<0.01), including the diameters are greater than > 45 mm within 5 pa- tients. Aortic stenosis and an early postoperative diameter greater than 40 mm m'e independent risk factors for redilatation. Conchusion Because of the unsatisfied midterm follow-up redilation of unsupported reduction aortoplasty for dilation of the ascending aorta with aortic valve disease, this group of patients needs continued intimate fallow-up or even reoperation. The patients of stenosis is the surtable indication for RAA, and it is necessary to reduce the diameter of aorta to be lees than 40 mm to prevent redilation.     

升主动脉成形术中期效果分析

Objective Reduction ascending aortoplasty is an alternative procdure to the replacement of the ascending aorts in case of ascending aorta dilation. However,its applicabikity is still under debate.This retrospective study was designed to evaluuate the midterm follow-up of unsupported ascending reduction aortoplasty for of the ascending aorta in petients with aortic valve dis- ease.Methods From October ,1996 to April,2007, a total of 54 patients with aortic valve disease and dilatation of the ascending aorta underwent unsupported reduction aortoplasty in combination with aortic valve replacement at our institution The diameter of the ascending aorta was measyred before and early after sugery and then later between 13 and 96 menths [mean (23 ±16)months] posto- perativeiy using echocardiography.Results Two patients were dead with thean overall perioperative mortality rate was of 3.7%. The reduction aortoplasty decreased the diameter of the aorta from (45.77±6.02) mm p～eope～afive]y to (34.67 ～4.81) mm early after surgery (P<0.01). During follow-up, the diameter d aorta increased from (34.67±4.81) mm early after surgery to (37.65± 6.35) mm after a mean follow-up of (23±16) months (P<0.01), including the diameters are greater than > 45 mm within 5 pa- tients. Aortic stenosis and an early postoperative diameter greater than 40 mm m'e independent risk factors for redilatation. Conchusion Because of the unsatisfied midterm follow-up redilation of unsupported reduction aortoplasty for dilation of the ascending aorta with aortic valve disease, this group of patients needs continued intimate fallow-up or even reoperation. The patients of stenosis is the surtable indication for RAA, and it is necessary to reduce the diameter of aorta to be lees than 40 mm to prevent redilation.     

升主动脉成形术中期效果分析

Objective Reduction ascending aortoplasty is an alternative procdure to the replacement of the ascending aorts in case of ascending aorta dilation. However,its applicabikity is still under debate.This retrospective study was designed to evaluuate the midterm follow-up of unsupported ascending reduction aortoplasty for of the ascending aorta in petients with aortic valve dis- ease.Methods From October ,1996 to April,2007, a total of 54 patients with aortic valve disease and dilatation of the ascending aorta underwent unsupported reduction aortoplasty in combination with aortic valve replacement at our institution The diameter of the ascending aorta was measyred before and early after sugery and then later between 13 and 96 menths [mean (23 ±16)months] posto- perativeiy using echocardiography.Results Two patients were dead with thean overall perioperative mortality rate was of 3.7%. The reduction aortoplasty decreased the diameter of the aorta from (45.77±6.02) mm p～eope～afive]y to (34.67 ～4.81) mm early after surgery (P<0.01). During follow-up, the diameter d aorta increased from (34.67±4.81) mm early after surgery to (37.65± 6.35) mm after a mean follow-up of (23±16) months (P<0.01), including the diameters are greater than > 45 mm within 5 pa- tients. Aortic stenosis and an early postoperative diameter greater than 40 mm m'e independent risk factors for redilatation. Conchusion Because of the unsatisfied midterm follow-up redilation of unsupported reduction aortoplasty for dilation of the ascending aorta with aortic valve disease, this group of patients needs continued intimate fallow-up or even reoperation. The patients of stenosis is the surtable indication for RAA, and it is necessary to reduce the diameter of aorta to be lees than 40 mm to prevent redilation.     

Aortic arch reconstruction with pulmonary autograft patch aortoplasty

OBJECTIVE: The optimal technique for aortic arch reconstruction through median sternotomy is still under debate. We have introduced the technique of pulmonary autograft patch aortoplasty as a reliable alternative. METHODS: The outcomes of 51 infants who underwent neonatal repair of interrupted aortic arch (n = 28) or coarctation associated with ventricular septal defect (n = 23) since 1992 were analyzed. The patients were reviewed in three groups according to the aortic arch reconstruction technique: group I underwent direct anastomosis (n = 23), group II underwent homograft or pericardial patch aortoplasty (n = 8), and group III underwent pulmonary autograft patch aortoplasty (n = 20). The pulmonary autograft patch consisted in the anterior wall of the main pulmonary artery, between the supracommissural level and the divided ductus arteriosus. The created defect was replaced with fresh autologous pericardium. RESULTS: All patients except 1 were discharged without significant residual gradient at the level of the aortic arch. At a median delay of 7 months (range 2-51 months), 11 patients (22%) had recurrence of arch obstruction and underwent balloon angioplasty (n = 8) or surgical correction (n = 3). One patient who had undergone direct anastomosis required reoperation for bronchial compression. At a median follow-up of 29 months, the actuarial freedoms from recurrent arch obstruction were 81% for direct anastomosis, 28% for homograft or pericardial patch aortoplasty, and 100% for pulmonary autograft aortoplasty (P =.03 for group III vs group I and P <.0001 for group III vs group II). CONCLUSIONS: The aortic arch repair associated with pulmonary autograft patch augmentation resulted in superior midterm outcomes and therefore constitutes a reliable alternative to the direct anastomosis technique. It allowed complete relief of anatomic afterload and diminished the anastomotic tension, thus reducing the risk of restenosis and tracheobronchial compression. We observed a significantly higher rate of recurrence after patch aortoplasty with other materials.     

Reverse subclavian flap repair of hypoplastic transverse aorta in infancy

BACKGROUND: Management of hypoplastic aortic arch associated with coarctation in infancy can be challenging. Reverse subclavian flap aortoplasty plus coarctation resection offers simplicity without needing foreign material or cardiopulmonary bypass. METHODS: Since 1988, 46 of 162 infants less than 3 months undergoing coarctation repair had hypoplastic arch enlargement with reverse subclavian flap aortoplasty. Median age was 11 days; mean weight was 3.2 kg. Thirty-seven patients (80%) had associated cardiac defects including single or multiple ventricular septal defects (14 infants), transposition of the great arteries (7), aortic or mitral stenosis (5), and complete atrioventricular septal defect (5 infants). Twenty-eight patients had pulmonary artery banding; 2 had an arterial switch operation through a separate median sternotomy. RESULTS: There were two hospital deaths: one 4 months postoperatively in a patient requiring a Norwood procedure the next day for underestimated left ventricular hypoplasia; the other of sepsis more than 1 month postoperatively. On follow-up from 1 to 129 months (mean, 38 months), there were five recurrent obstructions: three at the coarctation site treated with balloon dilatation and two at the arch site. Twenty-six children had their heart defects corrected with 29 subsequent operations including an arterial switch operation for transposition of the great arteries/ ventricular septal defect (3 infants), relief of aortic or mitral stenosis +/- ventricular septal defect closure (5), multiple ventricular septal defect closure (3), a bidirectional Glenn (2), complete atrioventricular septal defect (2), and anomalous left coronary with ventricular septal defect repair (1 infant). Four children await debanding and ventricular septal defect closure or Glenn anastomosis. There have been two late deaths (overall survival, 91%). CONCLUSIONS: Reverse subclavian flap aortoplasty is excellent for relief of arch hypoplasia and coarctation in infants with low recurrence rates and acceptable operative and intermediate survival.     

The use of pulmonary autograft patch for type A aortic interruption and Swiss-cheese ventricular septal defect (VSD)

The surgical management of the aortic arch pathologies is controversial. Primary anastomosis and patch aortoplasties combined with end-to-end anastomosis have some complications like recurrence and aneurysm formation. Surgical repair of apical muscular (Swiss-cheese) defects is also still under debate. A 6-year-old patient with diagnosis of type A aortic arch interruption and Swiss-cheese ventricular septal defect (VSD) underwent successful intracardiac repair and aortic arch reconstruction. Aortic arch reconstruction was done by end-to-side anastomosis of distal aortic archus and thoracic aorta without cardiopulmonary bypass. The anterior side of the anastomosis was augmented by using pulmonary autograft patch and this patch was extended to the inferior surface of the archus aorta. Swiss-cheese VSD was repaired with a single patch using septal obliteration technique via transatrial approach. Pulmonary autograft patch aortoplasty and end-to-side anastomosis may be an alternative surgical management for surgical repair and it may be done without the need for cardiopulmonary bypass. In these patients associated multiple apical muscular VSDs can be repaired with a single patch, septal obliteration technique.     

经胸骨正中切口一期矫治主动脉缩窄或主动脉弓中断合并心内畸形

目的 总结经胸骨正中切口一期矫治主动脉缩窄或弓中断合并心内畸形的经验.方法 2007年1月-2008年7月手术治疗24例.包括主动脉缩窄9例,主动脉缩窄合并主动脉弓发育不良12例,主动脉弓中断3例.4例合并右室双出口(Traussig-Bing型).22例合并非限制性室间隔缺损,2例不合并室间隔缺损病儿1例合并主动脉瓣下狭窄,另l例合并肺静脉狭窄.主动脉弓降部成形均在深低温低流量持续性选择性脑灌注下进行.3例主动脉弓中断及9例主动脉缩窄病儿采用端端吻合术.12例主动脉缩窄合并主动脉弓发育不良病儿中采用扩大端端吻合术8例,端侧吻合术2例,补片成形术2例.结果 死亡2例.全组病儿围术期未出现神经系统并发症及肾功能损害.术后反复呼吸道感染2例.除l例残存压差大于20mm Hg外,最长随访18个月,尚未发现再缩窄发生.结论 主动脉缩窄或弓中断合并心内畸形一经诊断即需尽早手术.经胸骨正中切口一期矫治是安全、有效的.充分切除动脉导管组织,广泛彻底游离松解胸部各血管进行无张力吻合以及选择恰当的组织一组织吻合术式是主动脉弓降部成形手术成功及减少再缩窄发生的关键.     

Off pump repair of aortic arch anomalies with concomitant intracardiac defects via anterior approach

BACKGROUND: The authors evaluated the surgical treatment of aortic arch anomalies associated with intracardiac pathologies, through median sternotomy on beating heart without using cardiopulmonary bypass (CPB). METHODS: A consecutive series of 10 patients with aortic coarctation were operated upon. Median age at repair was 3.5 months (range, 5 days to 72 months), median weight was 4 kg (range, 2.2 to 30 kg). All aortic obstruction repairs were done via midsternotomy without using CPB and it is used only for repair of intracardiac defects. The aortic reconstruction included resection and end-to-side anastomosis in six patients and pulmonary autograft patch aortoplasty in four patients. RESULTS: There was no operative mortality. Mean follow-up value was 17.6 +/- 8.07 months. There was no restenosis. CONCLUSION: Most of the aortic coarctation and interrupted aorta type A can be well-treated surgically through median sternotomy without using CPB. Thus, the need for profound hypothermia and circulatory arrest and its potential neurological and other side effects are removed and CPB is reserved only for associated intracardiac defects, if present.     

Composite aortoplasty for recurrent coarctation after neonatal repair in Williams syndrome

Supravalvar aortic stenosis is the most frequent operation required for Williams syndrome; however, coarctation repair is more common in patients requiring surgery in the first few months of life. We report on a child with Williams syndrome in whom extensive reoperation was required 5 months after neonatal aortic coarctation repair. A composite left subclavian artery flap and allograft patch aortoplasty of the aortic arch and descending aorta was performed through a left thoracotomy using cardiopulmonary bypass and circulatory arrest. Detailed anatomic evaluation of the aortic arch and descending aorta is recommended before initial coarctation repair in neonates with Williams syndrome.     

Surgical treatment of interrupted aortic arch in infants under three months of age

From March, 1982, through March, 1988, 8 infants less than 3 months of age underwent surgical treatment of interrupted aortic arch. Five patients had IAA type A and 3 patients had type B. Seven patients with associated VSD underwent staged operations and 1 infant with aortopulmonary window underwent primary repair off cardiopulmonary bypass. Aortic arch reconstruction was by subclavian aortic anastomosis (6) or large tube graft (8 mm) interposition (2) combined with pulmonary artery banding (5). All seven patients with associated VSD survived the first-stage operation. One patient subsequently underwent pulmonary artery banding, two underwent patch aortoplasty and four patients underwent intracardiac repair and removal of a pulmonary artery band, with six survivors (86%). The operative death occurred in an infant in whom modified Damus-Kaye-Stansel operation was carried out for severe subaortic stenosis, which rerouting all left ventricular blood through VSD and the main pulmonary artery into the ascending aorta and reconstructing right ventricular-distal pulmonary artery connection by a valved external conduit. All six surviving patients are doing well at present (mean follow up of 3 years) without any significant pressure gradient between the ascending and thoracic aorta. Based on these data we conclude: (1) Aortic arch reconstruction and pulmonary artery banding can be reliably performed even in critically ill infants with IAA and isolated VSD. (2) The primary repair will provide better chance of survival in infants with IAA associated with significant LVOTO, truncus arteriosus or aortopulmonary window that do not readily lend themselves to pulmonary artery banding.     

Growth of the aorta after prosthetic patch aortoplasty for coarctation in infants

We have shown that patch aortoplasty relieves the aortic pressure gradient substantially better than resection with end-to-end anastomosis in infants with coarctation of the aorta. Growth of the intact posterior wall of the unresected coarctation after aortoplasty, however, has not yet been demonstrated to occur. We studied 21 infants less than 2 years of age who underwent prosthetic patch repair of coarctation after 1975. Associated lesions were present in 16 patients, and 12 had a concomitant procedure. Two patients died in the hospital, and 4 died later, all of causes unrelated to the coarctation repair. Systolic blood pressure in the right arm declined from 140 +/- 41 mm Hg (mean +/- standard deviation) preoperatively to 101 +/- 19 mm Hg postoperatively in the whole group and to 95 +/- 12 in 10 patients followed for more than 3 years. The right arm-left leg systolic pressure gradient declined from 66 +/- 22 mm Hg to 5 +/- 14 in all patients and to 4 +/- 13 in the group followed more than 3 years. Hypoplastic transverse arch was seen in all but 2 patients. Its relative diameter increased in 6 of 9 patients who underwent catheterization postoperatively and increased more than 50% in 3 patients. Two patients have evidence of narrowing of the aorta at the patch, but both have normal blood pressure in the right arm. In the patient with longest follow-up, an 8-month-old infant seen 8 years after operation, angiograms show the diameter of the aorta at the coarctation to be greater than that at the transverse arch and at the descending aorta.(ABSTRACT TRUNCATED AT 250 WORDS)     

A case report--combined Jatene procedure and extended aortic arch reconstruction for the original Taussig-Bing malformation associated with hypoplastic aortic arch, subaortic stenosis and coarctation of the aorta]

A successful repair with combined Jatene procedure (Lecompte modification) and extended aortic arch reconstruction in a two-month-old boy with the original Taussig-Bing malformation, associated with hypoplastic aortic arch, subaortic stenosis and coarctation of the aorta was described. The ascending aorta was measuring 8 mm and the distal aortic arch was 4 mm in outer diameter. The interventricular rerouting was not feasible, because the infundibular septum was almost aligned to the interventricular septum. So that arterial switch operation was preferred. The primary interventricular foramen was enlarged by wedge resection and the secondary interventricular foramen was closed with a patch of preserved equire pericardium. An extensive patch angioplasty of entire aortic arch down to descending aorta was performed with a composite patch of Xenomedica (preserved equire pericardium) and Dacron velour. Hypertrophied muscle bundles were resected for relief of subaortic stenosis. Jatene procedure was then performed. During neo-pulmonary reconstruction, distal pulmonary orifice was shifted towards right to avoid kinking and compression on the coronary arteries. One stage correction consisting of Jatene procedure and extended aortic arch reconstruction was considered to be a procedure of choice in this type of complex anomalies.     

Risk factors for recoarctation and results of reoperation: a 40-year review.

BACKGROUND: We analyzed a single institution 40-year experience with children that had coarctation repair to define risk factors for recoarctation and to evaluate the results of reoperation for recoarctation. MATERIAL AND METHODS: Between 1957 and 1998, 271 patients had primary surgical repair of coarctation of the aorta. Techniques for primary repair included Gore-tex patch aortoplasty (PATCH; n = 118), resection with extended end-to-end anastomosis (RXEEA; n = 69), subclavian flap aortoplasty (SFA; n = 61), resection with simple end-to-end anastomosis (ETE; n = 18), resection and interposition graft (n = 4), and extra-anatomic graft (n = 1). Techniques for recoarctation repair included PATCH, interposition graft, and extra-anatomic graft. RESULTS: Median age at initial repair was 156 days. Major associated cardiac anomalies were present in 96 patients (35%). A hypoplastic aortic arch was present in 37 patients (14%). There were three early deaths (1%) and six late deaths (2%). One patient had paraplegia (0.4%). Recoarctation occurred in 29 patients (11%) and was most frequent with ETE and SFA repairs (33% and 20%, respectively). Multiple logistic regression analysis revealed ETE repair (p = 0.0002), SFA repair (p = 0.049), and aortic arch hypoplasia (p = 0.0001) to be risk factors for recoarctation. Using PATCH as the covariate, the odds ratio to develop recoarctation was 3.5 for SFA, 17.2 for ETE, and 15.2 for hypoplastic aortic arch. There was no mortality or paraplegia after recoarctation repair (n = 23). Six patients had seven balloon angioplasties; two of these patients later required reoperation. Three patients required a second reoperation for persistent coarctation. CONCLUSIONS: In our 40-year review, simple end-to-end anastomosis and subclavian flap repair had the highest incidence of recoarctation, especially when associated with aortic arch hypoplasia. We recommend resection with extended end-to-end anastomosis for repair of neonates and infants and Gore-tex patch aortoplasty for children over the age of 1 year. Surgical repair of recurrent coarctation is safe, effective, and has a low incidence of persistent coarctation.